Non-Payment by Insurer - Vehicle Questionnaire
Form Account (optional)
New Users / Returning Users
CLICK HERE
to setup or return to your account for this form. Creating an account enables you to return to this form and your submitted results. An account will also enable you to partially complete this form and return later to finish the form. The account you establish is only for this form.
1. Your Name:
2. Your e-mail address:
3. Your Telephone number:
4. Your postcode:
5. What is the approximate value of the vehicle concerned?
6. What has happended?
The vehicle has been stolen and was uninsured at the time of the loss
The vehicle has been stolen and insurers declined to pay out
Other:
7. Are you still in possession of the vehicle?
Yes
No
8. What is the registration number of the vehicle:
9. On what date was the vehicle stolen:
10. With regard to the Police, please provide, if known, the name, ‘collar number’, station, address and reference for the officer dealing with the investigation. If the matter has not yet been reported to the police, please enter ‘none yet’ in the field below:
11. Please use this part of the form to provide us a little more information about what happened to cause you to be in this situation:
Thank you for taking the time to complete this form. By clicking on the submit button below the information you have provided will be sent to us and we will return to you within the next 24 hours, providing documentation.